Relieve Your Allergies

Next time you're hit with hay fever, try to remember that things could be worse. You could be Clay Aiken. The American Idol also-ran is allergic to coffee, chocolate, shellfish, tree nuts, and mushrooms. And mints. Imagine going into anaphylactic shock because you wanted fresh breath. On the other hand, Aiken can easily avoid his triggers, something that, sans a SARS mask, is difficult to do if you're allergic to pollen. Or ragweed. Or her beloved cat.

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Inhaling allergens may be inevitable, but suffering isn't. We've developed a five-step plan that's the closest thing you'll find to an "off" switch for your overreacting immune system. Each step provides progressively more powerful medicine, taking you from a simple herbal treatment to cutting-edge science. And at no point will you need to do as Aiken did in his youth: Run over the cat.

Step 1: Consider your OTC options

With predicted sales of nearly $400 million in 2004, Claritin is the most popular over-the-counter allergy aid after Kleenex. But Claritin's two main selling points--maximum relief and minimum drowsiness--may be more hype than health benefit. In a study published in Annals of Allergy, Asthma and Immunology, researchers found that old-school Benadryl was actually 20 percent more effective in treating the itchiness and sneezing caused by seasonal allergic rhinitis, a.k.a. hay fever, than was Claritin. And in a separate study review, researchers determined that Claritin (as well as its cousins Zyrtec and Allegra) may actually have significant sedative effects, while diphenhydramine, the active ingredient in Benadryl, isn't as sedating as people think.

Bottom line: Try taking the smallest recommended dose of store-brand diphenhydramine: 25 milligrams (mg) every 6 hours. If that doesn't work, then try Claritin or, better yet, the store brand of the stuff (usually labeled "loratadine"). "One drug will work better on some people than on other people," says Richard Lockey, M.D., chief of the allergy division at the University of South Florida. "We're biologically diverse."

Step 2: Give Mother Nature a taste of her own medicine

The herbal supplement butterbur may sound like a turkey, but there's evidence that it really does work. Scottish researchers found that patients with grass and pollen allergies who popped 50 mg of the plant extract twice daily had 13 percent better nasal airflow than those who took a placebo. Another study published in the British Medical Journal reported that butterbur treated seasonal allergies nearly as well as the prescription medication Zyrtec. "It's effective against all symptoms of allergic rhinitis, including sneezing, itching, and conjunctivitis," says Andreas Schapowal, M.D., Ph.D., the author of the study.

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Butterbur is believed to block leukotriene, a chemical that causes allergic reactions, while at the same time controlling eosinophils, the white blood cells that accumulate when allergic reactions take place, says Dr. Schapowal. What's more, there's no sedating effect with butterbur. You can buy the supplement ($24 for 60 capsules) at most health-food stores or at iherb.com.

Step 3: Snort a legal drug

Unless drug companies invent an antihistamine suppository, there are basically two injection-free avenues for allergy meds: down the hatch or up the honker. And while OTC nasal sprays have gotten a bad rap for causing something called "rebound congestion," at least one prescription spray may be worth snorting. When researchers at the Institute for Allergy and Asthma gave allergy sufferers the nasal spray azelastine, Claritin and azelastine, or a placebo spray for 1 week each, they found that the first two groups experienced nearly identical 22 percent improvements in their nasal symptoms. The researchers' conclusion: Azelastine can help, especially those people whom Claritin can't.

"When it comes to nasal symptoms, sprays come out ahead," says Sheldon Spector, M.D., a clinical professor of medicine at UCLA and president of the California Society of Allergy and Immunology. If you don't respond to oral antihistamines, talk to your doctor about a prescription for azelastine.

Step 4: Get the drop on allergies

They do a lot of things in Europe we'd never think of doing here, like paying to watch soccer. But they may be onto something with their choice of allergy treatment. "Allergy drops are frequently used in Great Britain and in the majority of European countries," says Russell Roby, M.D., an allergy specialist in Austin, Texas. "I think they're more effective than allergy shots."

Physiologically, the drops, which go under your tongue, work similarly to shots: Repeated exposure to trace amounts of the offending allergen causes the body to build up a natural resistance. When researchers at the Imperial college of medicine in London recently reviewed 22 study trials, they determined that treatment with allergy drops results in a 34 percent reduction in symptoms, on average. It also significantly decreases the need for additional medications. Some U.S. doctors may be reluctant to prescribe allergy drops, so shop around until you find one willing to consider this option.

Step 5: Take your best shot

Despite its cartoon-villain name, Xolair could be what rescues you from runaway rhinitis when nothing else can. In a 4-month study published in the Journal of the American Medical Association, researchers found that patients receiving a monthly injection of Xolair experienced a 25 percent reduction in their seasonal symptoms.

Here's how it works: During most allergic reactions, our bodies produce an antibody called immunoglobulin E (IgE), which in turn triggers the annoying symptoms. Xolair blocks IgE. "Altering the molecular biology of the immune response is the wave of the future," says Dr. Lockey. Xolair is FDA approved only to treat asthma, but some doctors may prescribe it for other reasons, such as allergies.

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